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Nepal Newsletter

December 21, 2009

December 21, 2009

Dadeldhura, Western Nepal

Dear friends,

“While they were there, the time came for the baby to be born, and she gave birth to her firstborn, a son.  She wrapped him in cloths and placed him in a manger, because there was no room for them in the inn."

This morning I walked up a hillside, sat in the grass and read these words.  The sun was just coming up, catching in the trees and on the Himalaya snows 15 miles to the north.  It’s winter and this town is high in the mountains, so I was glad for a patch of sunshine.

After my quiet time, I came down and had a quick breakfast at the hospital guesthouse, then went on rounds with the doctors.  When I arrived, they were finishing in the medical ward and heading for the maternity ward.  There, each bed seemed to hold a woman with a story to tell.

Under the window was Kalawati, a mother of three who came from the district to the north.  Though only 30 miles wide, there are places in her district of Baitadi that can only be reached by two days’ walking.  Patients come from there to Dadeldhura because there is no functioning hospital.

A few days back when her birthing pains began, Kalawati knew to go to the cattle shed.  There, laying on straw spread on the ground – in the same room with water buffalo, cows, and goats – she labored.  It was where she had delivered her three previous children, now ages 10, 8, and 5.  She was not put in the stable because of lack of a room elsewhere, but because of a custom called ‘chow-padi’ – that a woman who is having menstrual bleeding must be separated from the rest of the household.  A majority of women here in far western Nepal go each month into the cattle shed until their menstruation stops.

When Kalawati’s husband looked in on her delivery, he saw that the baby was emerging hand first.  Family members carried her three hours to the sub-health post, where a health worker examined her and told them to go immediately to a hospital.  They then carried her two hours to the nearest road.  By this time it was night and few vehicles were moving.  Fortunately, two hours later a night bus came along and stopped for them.  When she boarded the bus, she still felt her baby moving. One hour’s journey along the rough road to the town of Kodpe , its movements ceased.  It had been eight hours since they had set off for medical treatment.

When they arrived at the TEAM Mission Hospital here in Dadeldhura, the doctors did an immediate cesarean section.   Kalawati survived, but the baby had already died.  After I spoke with her on rounds, a nurse came over and shook her head.

‘Just a bad situation.’  She gestured to the empty cot beside the woman’s bed.  ‘Right there, her husband was drunk last night.  Wife in this condition and she has this sort of husband.  Very bad.’

On some of the surrounding beds in the ward, babies lay under the attentive gaze of their mothers.  There were some medical success stories.  One young woman seemed lost in contemplation of her newborn’s fingers; after five unsuccessful years, she had finally had twins, a boy and a girl.  But whatever their outcomes, most had come to this hospital through great struggle:  Home conditions worse than the Bethlehem manger.  Houses located on impossibly steep mountains.  Little tenderness to be found in the experience of birthing their children.

Christmas is approaching and I’m stuck here in the far west of Nepal .  Three of us from NSI came out for a week of work at two partner hospitals – Bajhang and Dadeldhura.  We were to return to Kathmandu today.  Unfortunately, this is the second day of a three-day Maoist country-wide strike, so the roads are closed.  In fact, just about everything is closed.  In Bajhang, even the mule teams that carry bags of rice towards the Tibet border can’t move under threat of the political gangs.  The TV here in the guesthouse shows scenes from 400 miles away in Kathmandu : angry young men setting street fires and clashing with police.  The Prime Minister returning from the Copenhagen Summit yesterday had to travel back roads from the airport to his house in order to avoid the mobs.  My opinion is that it boils down to this: the Maoists are desperate to reclaim the power they gave up six months ago.  Street gangs produce surer results than does negotiation – and  so Nepal lies paralyzed under the ruse of ‘people’s liberation.’

Bearing in mind our scheduled flight this morning, the TEAM hospital administrator yesterday sought permission from the local Maoist chapter for us to travel four hours south to the airport.  Usually during road strikes, special dispensation is granted for medical vehicles and we were ready to leverage our medical status for all it was worth.  One problem was that the TEAM driver would have had to travel back to Dadeldhura alone, without the cover of our medical team.  This issue was solved when the Maoists said that they had an area leader who was in the airport town and wanted to come up to Dadeldhura.  The hospital agreed to give him a lift back after they dropped us off; the Maoists wrote our permission letter.  So, we seemed ready for the trip home – at least until our team began to watch more of the TV news from Kathmandu .  It didn’t look good.  We finally agreed that we should wait it out here until the strike is over.

TEAM Hospital Dadeldhura is one of NSI’s partner institutions.  We are building them up to conduct two types of training.  TEAM used one of our annual grants for the hospital to renovate their guesthouse, reasoning that better accommodation would improve retention of senior doctors.  So, our prolonged stay here happens to be in the Nick Simons Guesthouse.  And for a rural town, it’s not a bad place: carpeted and clean.  Nice bathrooms, with hot water which is appreciated in this wintry weather.

The phone here also works, so I call back daily to check on my home troops.  It’s nice to be missed but it would be better to be home.  They all shared my disappointment that we had to cancel today’s flight.  The districts between here and the airport have various local groups agitating, so travel is never a sure thing.  Deirdre and I spoke on the phone today about contingency plans in the event that I don’t make it home in time for Christmas.  How will she buy Zachary’s new sweater?  Who will bring Benjamin’s bike from my office where it is hidden?  I was informed that 220 cookies have been baked so far and are being iced today.  The smell carried through the phone line.

When I visit Kalawati this evening, her husband is at the bedside ranting.  His nose is pushed in and scarred – I imagine from some trauma.  Looming over her, he points his finger at his wife, accusing her of various things including being crazy.  It’s just four days since her operation and she still has an intravenous line in.  She’s a slender woman with a pretty face that appears worn down.  Her upper front teeth protrude slightly.  She wears a red scarf over her head.  She knows to say nothing in reply to him, only slouching down in the bed.  He’s drunk and won’t listen to the surrounding patients’ relatives or to me.  Finally, the nurse calls the night watchman, who cajoles the husband into going outside to get some food.  The maternity ward becomes peaceful again.  As I stand speaking with Kalawati, I am led to wonder what gift I could give her.

Tonight we eat dinner in a local hotel.  On account of the strike, the hotel’s front shutters are all locked down as if it’s closed.   We enter through a side door.   They are proud to tell us that they have a new tandoori oven and that we’re the first to try its naan bread.  On the way back to the guesthouse, we walk along the base of the hill where I’d sat early this morning.  It blocks out the sky to our left, but above and to the right the Milky Way stretches itself over the valley, stars spilling beyond the mountaintops to the north.  We turn off our flashlights and stop to gaze upwards.  Here in the clear mountain air, the night sky has texture – stars of different sizes and faint colorations, some distant, some close, surrounding and including us.

Wishing you a joyful Christmas and New Year,

With Love,
Mark, Deirdre, Zachary & Benjamin.

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